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Pharmacology Exam 2 > Drugs Affecting GI Secretions > Flashcards

Drugs Affecting GI Secretions Flashcards

1
Q

What are the underlying causes of GI Disorders?

A

Dietary Excess
Stress
Hiatal Hernia
Esophagea Reflux
Adverse Drug Effects
Underlying Diseases/Disorders
Peptic Ulcer Disease

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2
Q

What does drugs acting on GI Secretions do?

A

Decrease GI secretory activity

Block the action of GI secretions

Form protective coverings on the GI lining to prevent erosion from GI secretions

Replace missing GI enzymes that the GI tract or ancillary glands and organs can
no longer produce

Every drug works differently!

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3
Q

What is Peptic ulcer Disease?

A

Erosions in the lining of the stomach or adjacent areas of the GI tract

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4
Q

What are the symptoms of Peptic Ulcer Disease?

A

Gnawing, burning pain, often occurring after meals - worse when laying down

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5
Q

What are the cause of Peptic Ulcer Disease?

A

NSAID use ex ibuprofen. This becuase NSAIDS reduce prostaglandin secretion and prostaglandin protect the gastric mucosae.

Bacterial infection by Helicobacter pylori bacteria

Stress: physical and psychological

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6
Q

What are important things to remember when giving drugs that affect GI secretions in children?

A

Children may use antacids, H2 Antagonist’s & PPI’s.

Concerns for this age group would be electrolyte imbalances and interference with nutrition.

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7
Q

What are important things to remember when giving drugs that affect GI secretions in adults?

A

Some concerns would be:
* Overuse (OTC)
* GI discomfort continuing (OTC without following up for underlying cause)
* Electrolyte disturbance
* Interference with other drugs

There are many issues that may arise from long-term use - over a year can result to C-diff & bone loss.

The drugs have not been cleared safe for pregnancy/lactation and may enter into breastmilk

  • Misoprostol - will result in miscarriage (cat.x) - Abortifacient
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8
Q

What are important things to remember when giving drugs that affect GI secretions in older adults?

A

There may be long term effects when these drug are prescribed frequently

We should prescribe these with caution for patients with renal/hepatic impairments

Many OTC drugs contain the same agents and may also interfere with RX medication

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9
Q

What are the suffix(ex) and potential outlier for Histamine-2 (H2) Antagonists?

A

“tidine”

Cimetidine
Famotidine (most common)
Nizatidine

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10
Q

What are Histamine-2 (H2) Antagonists prescribed for?

A

Treatment of ulcers

Prevention of ulcers related to:
* Stress
* Long-term NSAID use

Treatment of GERD

Treatment of pathological hypersecretory conditions such as
Zollinger–Ellison syndrome

Relief of symptoms of heartburn, acid indigestion, and sour
stomach (OTC preparations)

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11
Q

How does Cimetidine work?

A

Cimetidine is a Histamine-2 (H2) Antagonist which block H2 receptor sites which reduces gastric acid secretion and pepsin production which leads to decreasing lvls of these.

It also and blocks release of hydrochloric acid

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12
Q

Which patients should we be cautious of prescribing Famotidine to?

A

Famotidine is a Histamine-2 (H2) Antagonist.
We should be cautious when giving this to patients with renal/hepatic dysfunction.

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13
Q

What adverse effects are associated with Nizatidine use?

A

Nizatidine is a Histamine-2 (H2) Antagonist and can cause adverse reactions related to:

GI effect : diarrhea or constipation

CNS effect: headache, dizziness, sometimes hallucinations, somnolence/confusion.

Cardiac arrythmias and hypotension because there are H2 receptors on the heart.

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14
Q

What drug interactions do we need to be aware of when giving a patient Histamine-2 (H2) Antagonists?

A

There are too many to mention but for all of them there is an increased risk of slower metabolism of the other medication which may lead to toxicity.

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15
Q

What are important things to assess for before giving a patient Cimetidine?

A

Cimetidine is a H2 antagonist.

Check for pregnancy/lactation
Impaired renal/hepatic function

Neurological status incl orientation & affect for adverse CNS reactions

Cardiopulmonary status incl pulse and BP

Abdominal assessment

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16
Q

What implementations should be do when giving a patient Nizatidine?

A

Nizatidine is a H2 Antagonist.

Oral drug should be admin. ac or with meals or at bedtime - because that is when the patient is most likely to have symptoms.

Monitor patient closely with IV admin. because this is when the patient is most at risk for arrythmias.

Monitor for potential drug-drug interactions

Comfort & Safety ex easy access to bathroom in case of diarrhea & assistance with ambulation due to CNS effect.

Teaching ex no dangerous activities until the know response to the drug.

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17
Q

What are the suffix(ex) and potential outlier for Antacids?

A

Carbonates : Sodium Bicarbonate & Calcium carbonate

Salts: Magnesium Salts & Aluminum Salts

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18
Q

What are Antacids used for?

A

Used when a patient have to much acid which may cause stomach upset or conditions that cause excess acid such as peptic ulcers, gastritis or hiatal hernias - a hernia that is pressing up on the stomach.

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19
Q

How does Antacids work?

A

They are a group of is an inorganic chemicals that work by neutralizing stomach acid by a direct chemical reaction.

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20
Q

What conditions should we be cautious of before giving a patient Antacids?

A

Any condition that can be exacerbated by electrolyte imbalance.

GI obstruction - would increase adverse effects.

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21
Q

What are some adverse reactions that may happen when a patient is taking Calcium Bicarbonate?

A

Calcium Bicarbonate is an Antacid and may cause adverse reactions such as rebound acidity - happens when stomach becomes alkaline from taking antacid so it produces more acid.

Alkalosis - from neutralizing effect.
Constipation or Diarrhea

Calcium Bicarbonate in particular may cause Hypercalcemia and Hypophosphatemia - because calcium and phosphate have an inverse relationship.

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22
Q

What are some drug-drug interactions that we should keep an eye out for when a patient is taking Antacids?

A

It may have an effect on the absorption of many other drugs.

Should be taken 1 hr before or 2 hrs after other drugs because antacids effect absorption of other drugs due to altered chemical composition of the stomach.

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23
Q

What assessments should we do before giving a patient Aluminum salts?

A

Aluminum salts are antacids and we should be assessing for Pregnancy/lactation
Renal dysfunction
Do a physical abdominal assessment

Labs:
Renal function
Electrolytes

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24
Q

What nursing conclusions’ can we make with a patient is taking H2 Antagonists?

A

Impaired comfort due to GI effect
Altered sensory perception
Injury risk related to CNS effect
Altered tissue perfusion risk
Knowledge deficit

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25
Q

What nursing conclusions’ can we make with a patient is taking Antacids?

A

Altered GI motility related to adverse effects.

Electrolyte imbalance risks

Knowledge deficit

26
Q

What implementations should be expect to make when giving a patient Sodium
bicarbonate?

A

Sodium bicarbonate is an antacid and we should expects implementations such as:

Giving other oral meds. 1 hr. prior or 2 hrs. after admin of antacid.

Chew tablets properly and drink water after.
Monitoring serum electrolytes

Asses for signs/symptoms of electrolyte imbalance and acid/base imbalance

Monitor for diarrhea/constipation- implement bowel program if needed

Monitor nutrition w. severe diarrhea or constipation result in poor food intake.

Educate for risk of acid rebound.

27
Q

What are the suffix(ex) and potential outlier for Proton Pump Inhibitors (PPI’s)?

A

“Prazole”

Omeprazole (OTC)
Esomeprazole (OTC)
Lansoprazole (OTC)
Pantoprazole
Rabeprazole

28
Q

What is Rabeprazole prescribed for?

A

Rabeprazole is a PPI and is given for treatment/prevention of ulcers

Treatment of GERD

Treatment of pathological hypersecretory conditions such as Zollinger–Ellison syndrome

29
Q

How does Pantoprazole work?

A

Pantoprazole is a PPI and act at specific secretory surface receptors to prevent the final step of acid production and
thereby decrease the level of
acid in the stomach

30
Q

What are some adverse effects to look out for when giving a patient Omeprazole?

A

Omeprazole is a PPI and we should be aware of potential side effects such as
CNS effect: dizziness & headache
GI effect: Diarrhea, abdominal pain and nausea.

31
Q

What drug-drug interactions should we teach a patient about and monitor for?

A

Benzodiazepines & phenytoin due to risk of increased toxicity.

Antiretroviral medications due to altered levels of these - might end up not being effective or toxic effect.

Anticoagulants can increase toxicity of some of these and decrease effect of others.

32
Q

What assessments should we do prior to giving a patient Lansoprazole?

A

Lansoprazole is a PPI and we should assess for Pregnancy/lactation

Do a neurological physical exam as well as an abdominal assessment.

33
Q

What conclusions could we make when a patient will be taking PPI’s?

A

The may have altered GI motility
Imbalanced nutrition risk - can alter absorption of nutrients.
Altered sensory perception (Kinesthetic and auditory) - Related to CNS effect
Injury risk
Knowledge deficit

34
Q

What implementations should we perform/teach patients when they are taking Esomeprazole?

A

Esomeprazole is a PPI.

Patients should not open, chew or crush capsules - should be swallowed whole to ensure therapeutic effectiveness.

Monitor for diarrhea - bowel program if needed

Monitor nutritional status - If GI effect is a problem. small frequent meals.

Safety/comfort measures -CNS effect

Follow up after 8 weeks if no improvement. Could be underlying conditions.

Patient education

35
Q

What is the drug that we need to remember for the drug category GI Protectants?

A

Sucralfate

36
Q

Why would we give Sucralfate to a patient?

A

To promote ulcer healing

37
Q

How does Sucralfate work?

A

Coats the injured area of the stomach which prevents further injury from the acids, pepsins and bile salts.

It also promotes ulcer healing.

38
Q

What would be a potential contraindication to giving a patient Sucralfate?

A

If the patient has renal failure because Sucralfate contains aluminum and therefore there is a risk of buildup of aluminum which may lead to aluminum toxicity.

39
Q

What is an adverse reaction to Sucralfate?

A

Adverse effect are rare.
Constipation most likely.

Sucralfate is a GI protectant.

40
Q

What are some drug-drug interactions that we and the patient should be aware of when administering Sucralfate?

A

Aluminum salts due to increased risk of aluminum toxicity.

Medications administered at the same
time because sucralfate could potential bind to the other drugs and prevent absorption.

41
Q

What assessments should we be doing before giving a patient an GI protectant?

A

Check for pregnancy/lactation & renal failure

Do a physical abdominal assessment.

42
Q

What are some nursing diagnosis that we would make when a patient is given Sucralfate?

A

Altered GI motility
Imbalance nutrition risk
Knowledge deficit

Sucralfate is a GI Protectant

43
Q

What implementations should we make when giving a patient Sucralfate?

A

Give drug on empty stomach 1 hr. before or 2 hrs. after meals & at bedtime. It needs to be given on empty stomach to adhere to the ulcer sites.

Monitor for GI pain

If antacids/antibiotics are ordered give these between sucralfate doses and not within 30 min.

Comfort/safety : Bowel program if needed, increase fiber & fluid to prevent constipation.

Patient teaching.

44
Q

Which drug should we remember for the drug class Prostaglandins?

A

Misoprostol

45
Q

Why would we give Misoprostol to a patient?

A

To prevent NSAID induced gastric ulcers
Typically given to patients in risk of developing an ulcer.

Misoprostol is a Prostaglandin.

46
Q

What is a relative contraindication to prescribing a patient Misoprostol?

A

Pregnancy (cat. X) - however these drugs can sometimes help a baby be born if mom is in labor and having trouble delivering.

Misoprostol is a prostaglandin

47
Q

What are some adverse reactions that we should be prepared to see when a patient is taking Misoprostol?

A

GI Effect: Nausea, diarrhea, abdominal pain.
GU Effect due to prostaglandin effect on the uterus : Miscarriages, excessive bleeding, menstrual irregularities.

Misoprostol is a prostaglandin

48
Q

What should we assess for before prescribing Prostaglandin agents to a patient?

A

Pregnancy/Lactation

Physical abdomen assessment.

49
Q

What nursing conclusion can we expect when giving a patient Misoprostol?

A

Altered GI motility
Impaired comfort
Imbalanced nutritional risk
Knowledge deficit

Misoprostol is a prostaglandin

50
Q

What implementation should we and the patient make when administering Misoprostol?

A

Serum pregnancy test within 2 weeks
before.

Begin therapy on 2nd or 3rd day of the menstrual period

Patient education regarding the associated risks of pregnancy: miscarriage and
excessive bleeding

Explain the risk of menstrual disorders, pain, excessive bleeding

Barrier contraceptives, if applicable

Monitor nutritional status
Safety/comfort measures

Easy access to bathroom facilities
Small, frequent meals
Patient teaching

51
Q

What two drugs should we remember for the drug category Digestive Enzymes?

A

Saliva Substitute

Pancrelipase (Pancreatic Enzymes)

52
Q

Why would we give a patient Pancrelipase?

A

Cystic fibrosis
Pancreatic insufficiency
Malabsorption syndrome

53
Q

Why would you give a patient Saliva Substitutes?

A

Dry mouth which may be associated with stroke, radiation therapy or chemotherapy.

Saliva Substitute are Digestive Enzymes

54
Q

How does Saliva Substitutes work?

A

They contain electrolytes
and carboxymethylcellulose to act as a
thickening agent - makes it easier to swallow and also start the digestive process.

Saliva Substitute are Digestive Enzymes

55
Q

How does Pancrelipase (pancreatic enzyme) work?

A

By replacing enzymes that our pancreas makes that help the digestion and absorption of fats, proteins, and carbohydrates.

56
Q

What is the absolute contraindication to Pancrelipase?

A

Allergy to pork - all pancreatic enzymes made from pancreas of a pig.

57
Q

What cautions should we be aware of when prescribing saliva substitutes to a patient?

A

Coronary Heart Failure
Hypertension
Renal failure

Due to abnormal absorption of electrolytes esp. sodium would complicate/worsen these conditions.

Saliva Substitute is a Digestive Enzyme

58
Q

What are some adverse effects that we should be monitoring for when we are administering Saliva Substitute to a patient?

A

Electrolyte changes such as increased levels of magnesium, sodium or potassium

Saliva Substitute is an Digestive Enzyme

59
Q

What are some adverse effects that we should be monitoring for when we are administering Pancreatic enzymes/ Pancrelipase to a patient?

A

GI irritation such as Nausea, Abdominal cramps and diarrhea due to direct GI irritation from drug.

Pancrelipase is an Digestive Enzyme

60
Q

what should we assess for prior to giving a patient Digestive Enzymes?

A

Allergies, contraindications and cautions

We should do a physical assessment of the abdomen and elimination patterns.

Check mucosal membrane.

Check cardiovascular system - due to potential electrolyte imbalances.

61
Q

What nursing diagnosis would we expect to make when administering Digestive Enzymes?

A

Swish saliva substitute around the mouth as needed – DO NOT SWALLOW

Administer pancreatic enzymes with meals and snacks

Pancreatic enzymes should not be crushed or chewed - can open capsule and sprinkle over food such as applesauce to be swallowed whole.

Monitor for electrolyte imbalances with saliva substitutes

62
Q

How does Misoprostol work?

A

Protects stomach by inhibiting gastric acid secretion.

Increasing bicarbonate and mucous production in the stomach.

Pharmacology Exam 2 (10 decks)

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